P0642 - Transjugular Intrahepatic Portosystemic Shunt Does Not Cause Regression of Portal Hypertensive Polyposis or Its Complications

Ioannis Pothoulakis, MD, Dharma Sunjaya, MD
University of Minnesota, Minneapolis, MN

Introduction: Portal hypertensive polyposis (PHP) is a rare complication of cirrhosis that can be seen in upper gastrointestinal endoscopy (EGD). This condition can remain asymptomatic, but can lead to complications, such as clinically significant bleeding requiring intervention. Management of these lesions remains unclear, but transjugular intrahepatic portosystemic shunt (TIPS) has been suggested as a possible option due to the reduction of portal pressures. We present a case of significant bleeding related to portal hypertensive gastric polyposis despite successful TIPS placement and normalization of hepatic venous pressure gradient.



Case Description/Methods: A 65-year-old man with history of cirrhosis presented to the emergency department with hematemesis. Four months prior, he was admitted with similar symptoms. During that encounter, EGD was performed showing type 1 isolated gastric varices (IGV1), type 2 isolated gastric varices (IGV2), portal hypertensive gastropathy, as well as multiple large portal hypertensive polyps in the cardia. Due to concern for variceal bleeding, Interventional Radiology performed gastric variceal embolization, along with TIPS placement. During this present visit, EGD was again performed, showing resolution of prior varices in the setting of recent TIPS. On the other hand, EGD revealed multiple pedunculated inflammatory appearing polyps, two of which were present in the cardia and were actively bleeding. Hemostatic clips were placed in the stalk with resolution of bleeding. Abdominal ultrasound confirmed the TIPS to be patent with good flow. Patient was discharged home the following day.

Discussion: To our knowledge, this is the first case report that addresses the role of TIPS in PHP. In our patient, TIPS did not lead in any regression of these gastric polyps and reduction in PHP related bleeding, at least in the short term. Further studies are required to explore the use of TIPS for this indication, but also identify other possible therapeutic approaches for PHP.



Disclosures:


Ioannis Pothoulakis, MD, Dharma Sunjaya, MD. P0642 - Transjugular Intrahepatic Portosystemic Shunt Does Not Cause Regression of Portal Hypertensive Polyposis or Its Complications, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.